what's going on all my healthcare brothers and sisters i hope that you are having a wonderful day the 2020 updated guidelines are out for the american heart association's basic life support and today we're going to be discussing what 2021 will hold for us when it comes to bls let's get started so one of the big changes that you're going to see to the 2020 guidelines is the change in the chain of survival so what the american heart association did was they added a sixth link called recovery to the end of the chain survival so really once we get that return of that spontaneous circulation it's really about the care and support during the patient's recovery so they recommended that after cardiac arrest these survivors should have multimodal rehabilitation assessments and treatment for physical neurological cardiopulmonary and cognitive impairment so when it comes to our basic life support it's really all about that c a b our compressions airway and breathing so when we find a potential victim we want to check for responsiveness of that patient by tapping firmly on them and above their collarbone if there is no response and i'm talking about you really need to tap it are you okay if you find no response you want to assess the environment for safety before beginning cardiopulmonary resuscitation why is because if you're out in the middle of the street and there are cars moving back and forth you can potentially become a victim yourself and if now we have two victims it's going to be a lot harder for people to do cardiopulmonary resuscitation on two people as well as activate the system so make sure that you were in a safe area before starting cpr next you want to activate the emergency response system by shouting for help and have another person obtain an aed or defibrillator something new that is recommended with the 2020 guidelines is that if you have a mobile device they want you to immediately activate the emergency response system as opposed to waiting for help because the quicker that you can get help to you the quicker we can save lives next you want to check for breathing and a pulse no more than 10 seconds we don't want to delay that life-sustaining cardiopulmonary resuscitation next you want to begin cpr if there is no pulse detected by starting chest compressions and these are high quality chest compressions however if a pulse is present and they have agonal breathing then we want to begin rescue breathing immediately like i said before the 2020 guidelines have updated regarding the activation of the emergency medical services so if you have a mobile device it's available it's handy you want to call early you don't want to wait for help if you already have the resources you need in order to activate the system so any area outside the hospital such as a parking lot make sure you activate that system as soon as possible so let's talk about chest compressions you want to place the palm of your hand over the patient's sternum just above that xiphoid process a previous indicator in the past updates was that the hand should be placed at the mid nipple line however due to the increase in obesity the nipple line may not be the best indicator when it comes to cpr so make sure that you're placing the palm of your hand just above that zyphoid process on the sternum when it comes to chest compressions we want to do between 100 and 120 per minute and in adults we want to compress at least two inches you also want to allow for full chest recoil between compressions and minimize interruptions to less than 10 seconds a lot of these that you see in red will be on your exam you want to switch compression team members every two minutes to avoid exhaustion of cpr lastly compression to ventilation ratio when it comes to adults you want to do 30 chest compressions to two rescue breaths something new that the american heart association is implementing as 2020 is the cpr coach and what this coach does is it's really dedicated to the quality of cpr they're critiquing the depth the rate and the recoil in this role can be combined with another rule such as somebody who's going to be handling the defibrillator it's really just a second person looking at cpr to make sure that we're doing it effectively and efficiently so let's take a look at the airway and breathing when it comes to our cab in our adult patients we want to utilize that head chin lift or draw thrust if there is a chance of cervical spine injury related to trauma we're going to provide rescue breaths one breath every six seconds for respiratory rest with or without an advanced airway this is a new guideline for 20 20. it used to be that you had differentiating ways of providing rescue breaths depending on what you had so if you had a bad mask valve device then you would provide one breath every five to six seconds for respiratory arrest or one breath every six seconds for ventilation with an advanced airway however they have now changed that for 20 20 to make it a little bit less confusing and now it is one breath every six seconds for respiratory arrest with or without an advanced airway in place you want to make sure that you're seeing visible chest rise and fall with each rescue breath and you also want to avoid excess ventilation because there is a potential reduction of cerebral blood flow related to a decrease in co2 levels if we are excessively ventilating these victims let's have a discussion about the aed and defibrillator what is the first thing you want to do whenever the aed arrives to the scene you want to turn it on and you want to follow the prompts provided by the aed next you want to open and remove the person's shirt now if this is a potential person who's very sweaty because of an mri or that you're a near drowning patient you want to make sure that you clear that wet barrier prior to putting the pads on it's also important that if you find any medication patches on the chest or the back that you also remove those as well next we're going to attach the aed pads to the right anterior chest and left mid axillary line per the pad instructions and we're going to plug the pads into the connector located on the aed we're going to stop chest compressions and confirm that everyone is clear by saying stand clear you want to make sure everybody hears you you're going to push the analyze button on the machine and allow the aed to analyze that person's heart rhythm if a shock is recommended you want to again check to make sure that everybody is clear and no one is touching the person and by saying stand clear once everybody's clear and you've confirmed it go ahead and hit the shock button and after the shock takes place you want to make sure that you begin cpr immediately if no shock is advised again you're going to start cpr immediately you're going to perform another two rounds of cpr and then again follow what the aed prompts tell you something that's really important to know when it comes to bls is when we do termination of resuscitation now if we're not in the field providing bls to a potential person then we don't stop bls until somebody gets there we want to continue to try to save lives however if in transit or when we get to the hospital it's really a discussion that we have as a multi-disciplinary team of when we decide to terminate resuscitation there's certain criteria that has to be met one of the criteria arrests not witnessed by emergency medical services personnel two no return of spontaneous circulation before transport and three no aed shock was delivered before transport if all of this criteria is present that is when we start to consider termination and resuscitation if any other criteria is missing we want to make sure that we're continuing resuscitation and we're transporting the patient to the hospital now let's take a look at the basic life support when it comes to pediatric persons we really need to understand the definition of neonate infant child and adolescent because depending on what age group they fall in it's really going to affect how we provide basic life support when it comes to our neonate they're going to be between 0 to 28 days our infant is going to be between 28 days to one year our child is going to be greater than one year but they have not reached puberty and when it comes to adolescence puberty will be present either through armpit hair or breast development so when it comes to basic life support in our pediatric patients we're again going to follow that cab sequence for cardiopulmonary resuscitation that's our compression airway and breathing you're going to begin by verifying the scene is safe so that you don't become a victim yourself you're going to check the patient for responsiveness by either tapping on the shoulders or you can tap on the heel if it's an infant patient and shouting are you okay if the victim does not respond you can shop for nearby help and activate the emergency response system again the 2020 updates have advised that if you have a mobile phone you yourself can activate that emergency response system immediately if nobody responds to you you do not leave the child so if you don't have a mobile phone you're unable to call someone and nobody is around you you don't leave the child you want to first perform one round of cpr prior to going and finding help next we're going to assess for our breathing no more than 10 seconds we want to check for rise and fall of the chest and if there is a pulse present when it comes to pulse checks in our infants we're going to palpate that brachial pulse and in our children we can either palpate the carotid or the femoral if we have an unresponsive no breathing no pulse pediatric person then we're going to begin cpr immediately now when it comes to our infant patients one of the 2020 aha guideline updates is there are now options for single rescuer cpr hand positions so in 2015 the only hand position you could use was the two fingers on the center of that infant's chest the lower half of the breastbone you also have that option in 2020 but you can also do two thumbs at the center of the infant's chest lower half of the breastbone or one hand in the center of the infant's chest lower half of the breastbone so whatever is more comfortable for you you now have options in 2020 one person rescuer for infants is 30 chest compressions to two breaths if you by chance have a second person rescuer it now switches to 15 chest compressions to two breaths and the reason is is because it provides for better coronary diffusion when it comes to a child you can either use the one or the two hand method chest compression should always be one third of the ap diameter of the chest so when it comes to infants that's approximately four centimeters children approximately five centimeters and no chest compressions in our pediatric persons persons should go beyond six centimeters chest compressions should always be between 100 and 120 per minute regardless if they are an infant child or adolescent so let's talk about the 20 20 american heart association bls updates when it comes to pediatric rescue breaths so after you perform every round of chest compressions ask the provider you want to provide rescue breaths so you want to provide one breath every two to three seconds so that's approximately 20 to 30 per minute with or without an advanced airway if you're providing cpr and there's an advanced airway in place then you want to give one breath every two to three seconds again that's between 20 to 30 breaths per minute accounting for the age and the clinical condition of that person infants it should be at least 30 breaths per minute and when it comes to older children we want to be providing at least 25 breaths per minute you want to make sure that you're seeing visible chest rise and fall to confirm that the rescue breaths we are providing are appropriate you also want to place the patient in a sniffing position for optimization of rescue breaths this really requires that you provide flexion and extension of the head and neck using that ec method if you're using a bag valve mask let's look at what the differences are when it comes to aed pad placement with our infants and our children if we have a potential person who is under the age of eight years old you want to always use the child pads if they are available some aeds may not come with child pads and if that is the case we can use the adult pads just with a little variation you want to place the pads on the potential person so that they are not touching each other that means that one pad is going to go on the chest and the second pad is going to go on the back the pad should really create a sandwich between the heart if they are placed appropriately if you have a potential person who is eight years of age or older you always want to use the adult pads do not under any circumstances ever use child pads because they will likely not provide the shock dose that is required in order to help restart the electricity of the heart upon our assessment of the person if they have a pulse but they are experiencing agonal breathing cpr might not be necessary we do however want to provide rescue breaths one breath every two to three seconds again that's 20 to 30 per minute with or without an advanced airway when it comes to ib io access io is still the preferred access for cardiac arrest in pediatrics over iv access when it comes to electrical resuscitation of our pediatric persons we have two options defibrillation and synchronized cardioversion in defibrillation it's a treatment for immediate life-threatening arrhythmias with which the patient has no pulse such as ventricular fibrillation or pulseless ventricular tachycardia the initial shock we can provide is two joules per kilogram if a second shock is needed we provide 4 joules per kilogram and each subsequent shock thereafter should be greater than or equal to 4 joules per kilogram we would never want to provide a shock over 10 joules per kilogram an easy way to remember this is 2 4 6 8 that's the dose to defibrillate when it comes to synchronized cardioversion it's a treatment that aims to convert an arrhythmia back to sinus rhythm such as atrial fibrillation and supravetricular tachycardia we typically use between 0.5 to 1 joules per kilogram when it comes to synchronized cardioversion now let's talk about foreign body airway obstruction in our adults and children we begin by asking the potential victim are you choking if that victim nods yes and cannot talk there is a severe airway obstruction present something really important that i want you to note your next question should always be can i help you most of the time your victims are going to say yes but there are times where people are going to say no either out of fear or anxiety or whatever their case may be if they say no you do not touch that potential victim because if you touch them and they didn't want help it is considered battery regardless of your clinical background if you had one or not so once they collapse and they are unresponsive consent at that point is implied so you can begin cpr however if they have given you permission you want to begin by providing abdominal thrusts like the high mitten remover or chest thrust for pregnant or obese patients who are responsive you're going to repeat these same abdominal thrusts or chest thrusts until the treatment is effective or the person becomes unresponsive so let's talk about foreign body airway obstruction when it comes to our infant victims if the victim cannot make any sounds or breathe we know that there is a severe airway obstruction present we're going to begin by placing the infant prone and we're going to give five back slaps and i'm talking some good back slaps then we're going to flip them over and we're going to provide five chest thrusts we're going to continuously repeat this until either the treatment is effective or that person becomes unresponsive if our victim becomes unresponsive while we're trying to help them with that foreign body airway obstruction then we want to immediately activate the emergency response system either by using your mobile phone or sending someone else for help after two minutes of cpr if you are alone with no cell phone you can leave that person to activate the emergency response system at that time you want to lower the person to the floor if they become unresponsive and begin that cpr by starting with chest compressions do not even bother looking for a pulse before you deliver rescue breasts we want to investigate the mouth if you see the foreign body and it's in an area which can be easily removed removed it because if you start providing rescue breaths there's a chance you can push that foreign body back into the airway you're going to continue cpr until advanced care providers arrive the opioid pandemic has never been more prevalent than it is today it's not only affecting our adults but it's also affecting our children so something that the american heart association really concentrated on when it came to the 2020 guidelines was opioid-associated emergencies for healthcare providers the changes to the algorithm include respiratory arrest is more prominently addressed in the beginning with is this person breathing normally an initial assessment with action steps is more clearly laid out with the initial is the person breathing normally question if yes the algorithm provides clear steps to prevent deterioration another big change was naloxone it's not as emphasized as it was before in 2015 it was a standalone box with recommended doses in 2020 it is under prevent deterioration and start cpr as consider naloxone with no doses if a patient with suspected opioid overdose who has a definite pulse but no normal breathing or only gasping such as respiratory arrests in addition to bls it is reasonable for providers to administer intramuscular or intranasal naloxone for patients known or suspected to be in cardiac arrest in the absence of a proven benefit from the use of naloxone standard resuscitation measures should be taken over naloxone administration with a focus on high quality cpr so let's take a look at the new algorithm so this is the new algorithm for the opioid associated emergencies for healthcare professionals we begin with step one suspected opioid poisoning we're going to check for responsiveness shop for nearby help activate the emergency response system either by using our mobile phones or asking someone else to do that and we want to get naloxone and a aed if it is available step two this is the big change is the person breathing normally if they are we move on to step three prevent deterioration we're going to tap and shout we're going to open the airway and reposition we're going to consider naloxone and we're going to transport to the hospital ongoing assessment of responsiveness and breathing you will always go back to step one if the person is not breathing normally the next question is does the person have a pulse and again we're going to assess for no more or equal to 10 seconds if they do we want to support ventilation we're going to open the airway and reposition provide risky breathing or bag mass device and we can give naloxone if they are not we're going to start cardiopulmonary resuscitation use an aed consider naloxone if we're going to refer to the bls cardiac arrest algorithm i hope this video is helpful in understanding the 2020 american heart association updates when it comes to the basic life support certification if you have any questions make sure that you leave them down below i love answering them make sure that you're following me on my social media i'm on facebook and instagram and make sure that you're subscribed here on youtube and turn on that bell notification so you're informed every time i post a new video go over and check out my website for all of the algorithms when it comes to the basic life support at www.nursecheong.com but until next time i hope that y'all are having a wonderful day and i will speak with you all again soon bye